How accurate is magnetic resonance angiography in predicting neurovascular compression in patients with trigeminal neuralgia? A prospective, single-blinded comparative study

Ninety-two patients with trigeminal neuralgia (TGN) were investigated prior to posterior fossa surgery with magnetic resonance imaging (MRI) and contrast-enhanced magnetic resonance angiography (MRA). The preoperative investigation was matched to one consultant neuroradiologist (co-author) who was b...

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Bibliographic Details
Published in:British journal of neurosurgery 2003-02, Vol.17 (1), p.60-64
Main Authors: PATEL, N. K, AQUILINA, K, CLARKE, Y, RENOWDEN, S. A, COAKHAM, H. B
Format: Article
Language:English
Subjects:
Biological and medical sciences
Contrast Media
Cranial nerves. Spinal roots. Peripheral nerves. Autonomic nervous system. Gustation. Olfaction
Decompression, Surgical - methods
Gadolinium
Humans
Magnetic Resonance Angiography - methods
Medical sciences
Nerve Compression Syndromes - complications
Nerve Compression Syndromes - diagnosis
Nervous system (semeiology, syndromes)
Neurology
Neurosurgical Procedures - methods
Prospective Studies
Sensitivity and Specificity
Single-Blind Method
Trigeminal Nerve - surgery
Trigeminal Neuralgia - etiology
Trigeminal Neuralgia - surgery
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Summary:Ninety-two patients with trigeminal neuralgia (TGN) were investigated prior to posterior fossa surgery with magnetic resonance imaging (MRI) and contrast-enhanced magnetic resonance angiography (MRA). The preoperative investigation was matched to one consultant neuroradiologist (co-author) who was blinded to the side of symptomotology. The imaging results were compared with the operative findings in all patients. In 76 patients MRA showed present neurovascular compression in accordance with surgical findings. Eight cases had no compression either on MRA or intraoperatively. Eight predictions of no compression were false and there was no false positive. Based on surgical findings, the sensitivity of MRA was 90.5% and the specificity 100%. In 19 cases MRA predicted bilateral compression of the trigeminal nerves. Only two cases had clinically bilateral TGN. We conclude that MRA with gadolinium enhancement is an extremely sensitive and specific method for demonstrating compression in TGN. As a result posterior fossa surgery can be recommended with confidence, and microvascular decompression remains the treatment of choice for TGN at the authors' centre.
ISSN:0268-8697
1360-046X
DOI:10.1080/0268869031000093735